depression

Depression has long been linked to an increased risk of dementia, and now a new study shows that prompt treatment of depression may reduce dementia risk in some patient populations.

The study’s findings were published in the journal Biological Psychiatry. Dementia, a disabling neurocognitive condition that primarily affects older adults, affects over 55 million people worldwide. There is no effective treatment for dementia, but identifying ways to help minimise or prevent dementia would help to reduce the disease’s burden.

The study was led by Jin-Tai Yu, MD, PhD, of Huashan Hospital, Shanghai Medical College, Fudan University, and Wei Cheng, PhD, of Fudan University’s Institute of Science and Technology for Brain-Inspired Intelligence. It was published in the journal Biological Psychiatry by Elsevier.

Professor Yu and Professor Cheng analysed data from the UK Biobank, a population-based cohort of over 500,000 people. The current study included over 350,000 people, including 46,280 people who were depressed. 725 of the depressed patients developed dementia during the course of the study.

Previous research into whether depression treatments such as pharmacotherapy and psychotherapy could reduce the risk of dementia yielded conflicting results, leaving the question unanswered. “Older people appear to experience different depression patterns over time,” Professor Yu explained.

“As a result, intra-individual variability in symptoms may confer a different risk of dementia as well as heterogeneity in depression treatment effectiveness in relation to dementia prevention.”

To address this heterogeneity, the researchers classified participants into one of four depression courses: increasing course, in which mild initial symptoms steadily increase; decreasing course, in which moderate- or high-severity symptoms begin but then decrease; chronically high course, in which severe depressive symptoms persist; and chronically low course, in which mild or moderate depressive symptoms persist.

Depression, as expected, increased the risk of dementia by 51% when compared to non-depressed participants, according to the study.

The degree of risk, however, was determined by the course of depression; those with increasing, chronically high, or chronically low course depression were more vulnerable to dementia, whereas those with decreasing course faced no greater risk than those without depression.

The researchers were most interested in learning whether receiving depression treatment could reduce the increased risk of dementia. Overall, depressed participants who received treatment had a 30% lower risk of dementia than untreated participants. When the researchers separated the participants based on depression course, they discovered that those with increasing and chronically low courses of depression had a lower risk of dementia with treatment, whereas those with a chronically high course had no benefit in terms of dementia risk.

“Once again, the course of ineffectively treated depression carries significant medical risk,” said John Krystal, MD, editor of Biological Psychiatry, noting that “in this case, symptomatic depression increases dementia risk by 51%, whereas treatment was associated with a significant reduction in this risk.”

“This suggests that timely depression treatment is required among those with late-life depression,” Professor Cheng added. “Providing depression treatment to those suffering from late-life depression may not only alleviate affective symptoms but also delay the onset of dementia.”

“The new findings shed some light on previous work,” Professor Cheng said. “The disparity between previous studies may be explained by differences in effectiveness across depression courses.”

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According to a Rutgers research, screening moms and dads for depression at paediatric clinics after their child’s first birthday, which is now normal practise, might identify families in need of mental health and other vital supports.

“Pediatric professionals can play an important role in detecting parental depression,” said lead author Ava Marie Hunt, who conducted the research while a student at Rutgers Robert Wood Johnson Medical School and is now a medical intern at Children’s Hospital of Philadelphia’s Department of Pediatrics. “However, current American Academy of Pediatrics guidelines only encourage screening for maternal depression in the first year of their infant’s life.”

This is especially crucial for parents who do not have a regular source of health care but nonetheless take their children to their well-child appointments.” The research, which was published in the journal Pediatrics, looked at screening for parental depression or mood disorders in paediatric health-care facilities after a child’s first birthday. One in every five households in the United States suffers from parental depression. Mothers who are depressed are more likely to have unstable bonds with their children and to engage in harsh parenting behaviours. Furthermore, maternal depression has been connected to the cognitive, behavioural, and physical health of children.

In the Rutgers study, researchers examined 41 studies including over 32,700 parents and carers of children over the age of 12 months; on average, the studies found that 25% of the parents tested positive for depressive symptoms.

Researchers discovered that structured screening programmes outside of the postpartum period in paediatric settings are uncommon, despite the fact that many parents tested positive for depression symptoms. According to the study, many parents who tested positive for depressed symptoms did not obtain adequate referrals or follow-up.

“Although doctors realise the need of screening for depression, many are uneasy about doing so,” said senior author Manuel E. Jimenez, an assistant professor of paediatrics and family medicine at Rutgers Robert Wood Johnson Medical School.

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“Those who do screen for depression frequently depend on observation rather than utilising proven screening techniques, and dads are frequently overlooked,” said co-author Sallie Porter, an associate professor at the Rutgers School of Nursing.

According to the findings, enhanced screening for parental depression over a broader age range and in a broader range of clinical settings has the potential to identify families in need of assistance. According to the study, more research is needed to determine optimal practises for connecting parents who screen positive for depression symptoms to resources and establishing a follow-up process.

A study co-author was Nila Uthirasamy, a research assistant at Rutgers Robert Wood Johnson Medical School.

Article by: Dr. Jyoti Kapoor, Senior Psychiatrist and Founder & Director of ‘Manasthali

1. Depression is not an illness, it is a state of mind. – Depressive Disorders are caused by neurochemical disturbance in brain which responds to antidepressant treatment. Like other bodily ailments, there is a physiological process involved in these disorders which disturbs the normal state of wellbeing. Just because there is no objective laboratory measure to identify these imbalances at present, doesn’t mean that depression is not an illness and that it should not be treated. There is enough empirical evidence to suggest mechanisms that cause depression and how effective treatment strategies are. Trust your doctor who is trained to handle these conditions rather than lay persons who air the myths regarding psychiatric disorders due to ignorance and distorted social belief systems.
2. Depression doesn’t happen if there is no stress or tension in environment.- Endogenous Depression can occur in the absence of a significant environmental stressor. There are hereditary and genetic factors involved in the causation of these disorders and psychosocial issues are often the triggers for onset of Depression and not the cause of it.
3. Depression can be controlled by will power.- Endogenous depression occurs due to a biological vulnerability to develop neurochemical imbalances which leads to persistent state of sadness. During this phase, patient isn’t able to use his will power alone to get out of the state of depression. Negative thinking, lack of interest and inability to feel good are part and parcel of Depressive disorders. Understanding and support help the individual to open up about their inability to handle negative emotions and empathic treatment helps to guide them out of this sense of helplessness. Medicines help correct the neuro chemical imbalance faster along with which psychological strategies help combat the issue in professional setting.
4. There is no cure for Depression.- Depressive disorders are treated with medication and psychotherapy and response to treatment modalities is generally good. When treated early, response rate is even better and patient is able to withdraw from medicines with regular and rational treatment approach. With adequate treatment, depressed individuals are able to lead normal life and carry on routine activities like any no – depressed individual.
5. Children have no business getting depressed as they have no stress.- No age group is immune to depression. Children as young as 5 years of age have shown signs of depression and it need not always be a reaction to a major environmental stressor. Children often show more behavioural ( crying / irritability/ tantrums etc.)or physical symptoms ( nausea, lack of appetite, stomach ache, headache etc.) than telling that they are feeling sad or have negative thoughts. If parents try to deny or ignore the symptoms due to there own fear of acknowledging that the child may have a psychological issue, timely intervention is impeded with long term negative consequences.
6. Depression is normal for elderly people, lonely people or people with no one to talk to.- Although loneliness increases the vulnerability to depression, it’s not a cause for it. Depression isn’t a normal state of mind for elderly people or people who are single or widowed. We all develop coping abilities to handle life situations and people vulnerable to develop depression often use ineffective coping strategies to handle situations like being old or alone. With corrective coping skills, reactive depression can be treated.
7. Depression is caused by evil spells (jaadu-tona).- Like hypertension and diabetes, Depressive disorders are cause by chemical disturbance in a part of body ( in this case brain is the part of body affected). These disorders are not caused by black magic and don’t restrict treatments by spiritual healers ( ojha- tantrik/ jhaad- phoonk).
8. Antidepressants are only meant to sedate and are addictive.- All antidepressants are not sedative. The goal of treatment is to help the individual lead a happy, healthy life and not to put him to sleep. Initial side effects of some antidepressants produce drowsiness and the effects vary from person to person. Treatment is thus individualised based on effects and side effects. Antidepressants are generally non addictive if taken under supervision. Some drug companies have combination pills with antidepressants and sedatives which if continued without guidance can cause sleep related issues upon sudden withdrawal. A rational approach to treatment of Depression is to avoid combination formulas, to adequately educate patient about effect and side effects of medicines, to maintain regular follow up with psychiatrist even during asymptomatic maintenance phase and to introduce life style measures and psychotherapy at the right time of treatment.
9. All psychiatric problems are called Depression.- All psychiatric and psychological issues are not Depression. Depressive disorders are specific, symptom based category of mood disorders which requires specialist intervention. Correct diagnosis and timely intervention alleviates suffering and reduces dysfunction associated with depression. Like any chronic illness, precautions are needed to avoid or handle relapses.